A Novel Approach to Critical Congenital Heart Disease (CCHD) Screening at Moderate Altitude

Lueth, Erin T.; Russell, Leilani; Wright, Jason T.; Duster, Mark; Kohn, Mary; Miller, Josh; Eller, Cindy; Sontag, Marci K.; Rausch, Christopher M.

doi:10.3390/ijns2030004

Cited by 6 publications

(15 citation statements)

References 28 publications

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“…High oxygen concentrations eliminate the need to consider fetal versus adult haemoglobin issues or variations in P 50 of different ethnic groups. The excellent study by Lueth et al 13 was performed at moderate altitude, and we do not know if their use of 26% oxygen would apply at higher altitudes. 3.…”

Section: Practical Considerationsmentioning

confidence: 88%

Pulse oximetry in neonates at high altitudes: a modified Colorado protocol

Hoffman

2020

Cardiol Young

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AbstractPulse oximetry for detecting critical CHD produces more false positive tests at high altitudes than at sea level, because at altitude the average resting saturation is lower and the variability is higher. This increases diagnostic difficulties, especially in small isolated communities without paediatric echocardio-graphy, and requires expensive transport to a regional medical centre. One way of reducing diagnostic errors is to measure arterial oxygen saturation while the infant is breathing 100% oxygen. In the absence of right-to-left shunting through the heart, the ductus, or the lungs, arterial oxygen tension will exceed 150 mmHg and arterial oxygen saturation will be 100%. With right-to-left shunting, arterial oxygen tension will be <100 mmHg, and thus <96% (usually much lower).

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Section: Practical Considerationsmentioning

confidence: 88%

Pulse oximetry in neonates at high altitudes: a modified Colorado protocol

Hoffman

2020

Cardiol Young

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“…Additionally, a study performed by Lueth and colleagues evaluated a modification to the AAP-recommended screening protocol with transient oxygen supplementation in newborns at moderate altitude. Their intent was to replicate sea-level atmospheric oxygen tension and induce pulmonary vasodilatation to potentiate the neonatal transition [11]. This group found an increase in specificity of screening with a reduction in false positive screens by providing transient supplemental oxygen to newborns with an indeterminate or borderline first screen at moderate altitude [11].…”

Section: Discussionmentioning

confidence: 99%

“…Their intent was to replicate sea-level atmospheric oxygen tension and induce pulmonary vasodilatation to potentiate the neonatal transition [11]. This group found an increase in specificity of screening with a reduction in false positive screens by providing transient supplemental oxygen to newborns with an indeterminate or borderline first screen at moderate altitude [11]. Because low oxygen saturation in CCHD is primarily caused by shunting of de-oxygenated blood to the systemic circulation, oxygen supplementation in clinical practice does not typically normalize the percent saturation to greater than 95% in hypoxemic CCHD.…”

Section: Discussionmentioning

confidence: 99%

“…The performance of pulse oximetry screening has been evaluated in many studies performed at sea level [10], however, studies at altitude are limited [3,11]. Evaluation of the effectiveness of pulse oximetry screening guidelines is complicated due to the small number of infants likely to be identified through newborn screening as many infants with CCHD are diagnosed prenatally or in the first 24 h of life, thereby reducing the potential number of infants with undiagnosed CCHD eligible for screening with pulse oximetry.…”

Section: Introductionmentioning

confidence: 99%

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Pulse Oximetry Values in Newborns with Critical Congenital Heart Disease upon ICU Admission at Altitude

Kim

Ariefdjohan

Sontag

et al. 2018

IJNS

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Pulse oximetry screening for critical congenital heart disease (CCHD) has been recommended by the American Academy of Pediatrics (AAP). The objectives of this study are to describe saturation data, and to evaluate the effectiveness of AAP-recommended pulse oximetry screening guidelines applied retrospectively to a cohort of newborns with known CCHD at moderate altitude (5557 feet, Aurora, Colorado). Data related to seven critical congenital heart disease diagnoses were extracted from electronic health records (pulse oximetry, prostaglandin administration, and oxygen supplementation). Descriptive epidemiologic data were calculated. 158 subjects were included in this analysis; the AAP pulse oximetry screening protocol was applied to 149 subjects. Mean pre-ductal and post-ductal pulse oximetry values of the infants known to have CCHD at 24 h of life were 87.1% ± 7.2 and 87.8% ± 6.3, respectively. Infants treated with prostaglandins and oxygen had lower oximetry readings. The screening algorithm would have identified 80.5% of infants with known CCHDs (120/149 subjects). Additionally, sequential pulse oximetry screening based on the AAP-recommended protocol was able to identify a true positive screen capture rate of 80.5% at moderate altitude.

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“…Several studies have assessed the differences and made recommendations for either adjusting the acceptable target saturations or providing a small amount of nasal cannula oxygen to compensate, referred to as the altitude adjustment (Guo et al, 2020;Lueth et al, 2016;.…”

Section: Themesmentioning

confidence: 99%

An Altitude Adjustment: Implementing a Clinical Practice Guideline in the Newborn Nursery at Moderate Altitude

Blaskowsky¹

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Practice Problem: All infants undergo many changes at birth, but for some, the transition from intrauterine to extrauterine life presents more of a challenge, especially at altitude. Despite continuing research, neonatal prescribing guidelines for oxygen therapy remain ambiguous. PICOT: For term and late preterm infants requiring oxygen beyond transition, does a clinical practice guideline compared to practice without a guideline, provide consistent, evidence-based care, support the mother-infant dyad, and impact nursing perceptions over a six-week pilot period? Evidence: Birth at moderate altitude presents the newly born with less oxygen than those delivered at sea level. Several studies have assessed the differences and make recommendations for modifying acceptable saturations or compensating with a small amount of nasal cannula oxygen (the “altitude adjustment”), but recommend further study before broad application. Intervention: A consensus guideline for oxygen administration, weaning, and echocardiogram for indeterminate CCHD screens was created and implemented to facilitate care and practice consistency for patient safety and maintain the mother/infant dyad in a unique nursery setting. Outcome: After implementation, two infants demonstrated persistent pulmonary hypertension of the newborn, were treated with supplemental oxygen, and had normal ECHOs for age at discharge. These babies may have worsened without supportive treatment or required rehospitalization, demonstrating clinical significance for the pathway in the guideline. Conclusion: A shared-practice guideline for infants requiring supplemental oxygen following delivery was the focus of this EBP project. Evidence supports practice consistency by using guidelines and pathways across many disciplines, and engaging nurses in bringing evidence-based practice to the bedside improves patient outcomes.

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A Novel Approach to Critical Congenital Heart Disease (CCHD) Screening at Moderate Altitude

Cited by 6 publications

References 28 publications

Pulse oximetry in neonates at high altitudes: a modified Colorado protocol

Pulse oximetry in neonates at high altitudes: a modified Colorado protocol

Pulse Oximetry Values in Newborns with Critical Congenital Heart Disease upon ICU Admission at Altitude

An Altitude Adjustment: Implementing a Clinical Practice Guideline in the Newborn Nursery at Moderate Altitude

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